Lege Artis Medicinae

[Change of resistance among Gram-positive bacteria]


MARCH 20, 2001

Lege Artis Medicinae - 2001;11(03)

[Physicians are faced with increasingly rapid emergence and spread of antibiotic resistant Gram-negative bacilli and, in particular, Gram-positive bacteria. It poses a major problem for hospitals and general practice as well. The article focuses on the change of resistance of four important and frequently occurring Gram-positive bacteria (Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus spp. and Streptococcus pneumoniae). Among the therapeutic choices recently introduced fluoroquinolones, oxazolidinones, streptogramins and ketolids are reviewed.]



Further articles in this publication

Lege Artis Medicinae

[Treatment of invasive fungal infections: present and future]


[In immunocompromised patients morbidity and mortality caused by invasive fungal infections is increasing. It is difficult to establish early diagnosis of mycosis by laboratory tests currently available. Antifungal drugs are often toxic, their spectrum of action is limited and their cost is substantial. In the search for alternative therapeutic modalities, antifungal compounds were synthesised against several targets of the fungal cell. At present, the following drugs have almost completed drug registration procedures: voriconazole, posaconazole and ravuconazole from the new azol group, a candin named caspofungin, and the polyene liposomal nystatin. Nikkomycin Z, sordarins and some other compounds are also seem to be promising. In addition to new antifungal drugs, substantial improvement in the outcome of invasive fungal infections requires extended diagnostic capabilities, as well as a reappraisal of our principles of prophylaxis and treatment.]

Lege Artis Medicinae

[Treatment of pneumothorax in cystic fibrosis]


[INTRODUCTION - More and more children affected by cystic fibrosis reach adulthood. The frequency of complications, such as pneumothorax, increases parallel with the long disease course. PATIENTS AND METHODS - The treatment of 17 manifestations of pneumothorax in 10 young adult cystic fibrosis patients in our institute was analysed retrospectively. RESULTS - Depending on the extension of pneumothorax and the clinical state of the patients the first choice of the treatment was observation alone in 6 cases, insertion of pleuracan in 3 cases and tube thoracostomy in 8 cases. Due to ineffective suction, thoracotomy was necessary in 6 patients, bilaterally in 3 cases. CONCLUSION - The outcome of conservative treatment even in "small, circumscribed pneumothorax" cases of symptom-free patients is uncertain and risky. Insertion of a pleuracan is recommended only in urgent, life-threatening cases, but definitive result should not be expected. If possible, chest drainage should be chosen as the first procedure. After 5-7 days of ineffective chest suction, thoracotomy is mandatory. Recurrence of the pneumothorax is direct indication for surgery. Antibiotic treatment is suggested for the duration of drainage, as well as for the surgical procedure.]

Lege Artis Medicinae


Lege Artis Medicinae

[A devoted army medical officer]


Lege Artis Medicinae

[Effectiveness of patients’ rights]

VAJDA Angéla

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Hypertension and nephrology

[Infections associated to vesicoureteral reflux disease in children below 1 year of age: the infulence of continuous antibiotic prophylactic therapy on the prevalence of resistant pathogenic bacteria]


[Background: The primary goal when children with vesicoureteral reflux disease (VUR) are treated is the prevention of pyelonephritis and persisting renal damage. Continuous antibiotic prophylaxis (CAP) is usually applied to reach this aim. The selection of resisting pathogens is the major risk of CAP. The aim of our survey was to describe the patterns of pathogenic strains leading to pyelonephritis in patients treated with and without CAP. Patients and method: The pathogenic strains implicated in pyelonephritis were identified in 48 and 56 children below 1 year of age who were treated with or without CAP, respectively, between years 2006 and 2011. Results: Breakthrough urinary tract infections developing in the presence of CAP are more frequently (with about a double risk) caused by polyresistant bacteria compared to infections that emerged without CAP. Nevertheless, it should be noted that the prevalence of resistant pathogens was about 40% even in infants without CAP. Discussion: The pattern of pathogenic strains leading to pyelonephritis alters significantly even in the cohort of children below 1 year of age treated with CAP to prevent infections associated to VUR. The risk may be decreased through the rational use of antibiotics. To reach this goal national guidelines on VUR should be updated and the role of additional non-antibiotic treatment should be established.]

Clinical Oncology

[Fusions in solid tumors]


[Genetic fusions are the cosequence of genomic rearrangement including chromosomal inversion, interstitial deletion, duplication, amplifi cation, translocation. Fusions can influence tumor development and progression. Fusions fi rst discovered in hematological malignances (e.g. BCR-ABL), butlater more and more were identified dueto the higly sensitive NGS. It has been found that the oncogenic fusions are in minority in a given tumor. Today, some fusions were apprevedas targets (ALK, ROS1, PDGFB) by FDA. Asino ther targeted therapy resistance is in evitable, which is a very important challenge for newly designed drugs.]

Lege Artis Medicinae



[INTRODUCTION - Streptococcus pneumoniae (S. pneumoniae) is a very important pathogene of community acquired invasive infections. The aim the study was to collect data on the serotype distribution of invasive S. pneumoniae strains in Hungary and their resistance. In the light of the results it can be determined how effective the currently available polysaccharide vaccine is against the infections caused by invasive S. pneumoniae strains. MATERIALS AND METHODS - The seroprevalence and antibiotic sensitivity of 44 randomly selected isolates of Streptococcus pneumoniae isolated from sterile sites of human body were analysed over a 4 year period (2000-2003). Samples were randomly analysed by the Quellung method. Detection of sensitivity of S. pneumoniae to penicillin and erythromycin were carried out by disc diffusions and E-test method in the microbiological laboratory of the St. Laszlo Hospital. RESULTS - The invasive isolates belong to 22 different serotypes. The prevalence of penicillin and erythromycin sensitivity was 79,5%, and 68% respectively. CONCLUSION - The 23 valent polysaccharide vaccine could provide coverage of 82% of invasive pneumococcal diseases caused by strains analysed in this study.]

Lege Artis Medicinae

[The altered role of coagulase-negative staphylococci]


[Coagulase-negative staphylococci are differentiated from the more virulent Staphylococcus aureus by their inability to produce coagulase enzyme. Currently, more than 40 recognized species of coagulasenegative staphylococci are known. The great majority of these bacteria are normal inhabitants of the human skin and mucous membranes. Therefore, it is very difficult to distinguish isolates that are of clinical significance. Recently, coagulase-negative staphylococci have been increasingly detected to cause clinically significant infections. This is due in most cases to the increasing use of medical devices inserted or implanted in the human body. This overview discusses the various infections caused by these microbes, as well as their pathogenesis, epidemiology, and management.]

Lege Artis Medicinae

[Clinical impact of acetylsalicylic acid resistance in patients with cerebrovascular disease]

FEHÉR Andrea, PUSCH Gabriella, HARANG Gábor, GASZTONYI Beáta, PAPP Előd, WERLING Dóra, MENYHÁRT Marianna, KOMÁROMY Hedvig, SZAPÁRY László, FEHÉR Gergely

[INTRODUCTION - In the past few years, a number of studies have been published about acetylsalicylic acid resistance and its potential clinical consequences. PATIENTS AND METHODS - 281 patients with chronic cerebrovascular disease have been involved in our study. The patients were divided in two groups on the basis of their optical aggregometer results (acetylsalicylic acid responder vs. resistant). We compared the risk profiles, drug therapies, laboratory parameters and clinical outcomes of the two groups. RESULTS - Acetylsalicylic acid resistant patients were more likely to be women [23 (45.1%) vs. 92 (40%) (p<0.05)], to smoke (38% vs. 25%), have hypertension (92 vs. 78%), hypercholesterolaemia (5.69 vs. 4.85 mmol/l), and elevated LDL-levels (3.71 vs. 2.85 mmol/l), triglyceride levels (2.78 vs. 1.97 mmol/l) and hsCRP levels (17.89 vs. 7.09 mmol/l) (p<0.01). The use of statins was more frequent (56% vs. 36%) in the responder group (p<0.01). Platelet aggregation values (triggered by agonists) were significantly correlated with cholesterol, LDL, triglyceride and hsCRP levels (p<0.05). Adverse outcomes were reached in 13 (25.5%) acetylsalicylic acid nonresponders and 32 (13.9%) acetylsalicylic acid responder patients (p<0.01). In a multivariate analysis, however, only smoking (OR: 2.38, CI: 1.77-5.44) and increased LDL (OR: 3.01, CI: 2.34-5.67) and hsCRP levels (OR: 2.44, CI: 1.55-7.02) (p<0.05) were independent risk factors of adverse vascular outcomes. CONCLUSION - On the basis of our results, acetylsalicylic acid resistance was associated with a worse clinical outcome, but it was not an independent risk factor of future ischaemic events. Our results implicate that inappropriate prevention therapy might have a role in this phenomenon.]